Hematology #1

Question 1

Normal lab values: WBC, Plt

Answer 1

WBC: 5k-10k

Plt (thrombocytes): 150k-400k

Question 2

Normal lab values: Na, K, Cl

Answer 2

Na: 135-145
K: 3.5-5.0
Cl: 95-107

Question 3

Normal lab values: CO2, BUN, creatine

Answer 3

CO2: 22-26
BUN: 10
Creatine: 1

Question 4

Plasma

Answer 4

Fluid part of blood,

• 91% is H2O
• 7% are proteins, primarily albumin

Question 5

Primary factors for oncotic pressure

Answer 5

#1: Na 
#2: proteins (albumin)

Question 6

Consequences of low albumin level

Answer 6

1. Decreased oncotic pressures - 3rd spacing

2. Decreased drug binding = increased bioavailability drug per dose

Question 7

High BUN

Answer 7

Decreased kidney function

-high levels of products normally excreted.

Question 8

What is the best colloidal solution during a traumatic resuscitation?

Answer 8

Blood

Question 9

What is the target MAP during a trauma resuscitation?

Answer 9

80-90 mmHg

Question 10

Deliberate hypotension technique

Answer 10

Intentional hypotension to limit bleeding and keep clear surgical fields during surgery.

• requires intensive hemodynamics monitoring
• not performed prehospital

Question 11

Permissive hypotension

Answer 11

BP maintained normal to slightly low to limit bleeding

Question 12

Blood should only be administered with NS, why not LR?

Answer 12

LR has calcium component
-blood contains calcium kelating to prevent clotting in bag, can be overwhelmed by calcium in LR resulting in clotting in the line.

Question 13

Von Willembrand’s Factor

Answer 13

Free flowing in blood. Adhere to exposed collagen, then to platelets.

Question 14

Individual platelets adhere to one another by which 2 factors?

Answer 14

• G2B3A receptors

- thromboxane A2 (TXA2)

Question 15

Thromboxane A2 development

Answer 15

Tertiary development from prostaglandins

ASA / NSAIDs interfere with prostaglandin conversion to TXA2

Question 16

Extrinsic Clotting cascade

Answer 16

Damaged tissue, exposed collagen and thromboplastin.

Question 17

Where are the highest concentrations of thromboplastin?

Answer 17

Brain and placenta

-thus high incidence of DIC in head and pregnancy related trauma

Question 18

Intrinsic clotting cascade

Answer 18

Damage to inside of the vessel wall (endothelium)

Question 19

Which cation is most important during the clotting cascade.

Answer 19

Calcium

-low Ca levels result in malfunction of clotting cascade

Question 20

Extrinsic pathway to final common pathway

Answer 20

Tissue damage => release of thromboplastin from tissues => activates factor X => final common pathway

Question 21

Intrinsic pathway to final common pathway

Answer 21

Blood vessel damage => cascade of clotting factors in the blood => activates factor X => final common pathway.

Question 22

Final common pathway

Answer 22

Factor X converts prothrombin to thrombin => converts fibrinogen to fibrin => blood clot

Question 23

Fibrin clot break down

Answer 23

Plasminogen within clot converts to plasmin => clot breaks down to fibrin degradation products.

Question 24

Normal lab values: RBC, Hgb, Hct

Answer 24

RBC is 5, x3= Hgb, x3=Hct

RBC: 5
Hgb: 15
HCT: 45 (% blood that is not fluid)